The present invention relates to benefits administration systems and methods of use and doing business. The present invention also relates to automated systems for administering benefits.
In business and industry, benefits plans are common. They often include health care, savings or retirement plan, insurance, and other funding or services for employees. Administration of benefits has long presented a substantial challenge for business and industry.
One prior art automated system designed for administration of benefits has been known as the “Phoenix” system. The Phoenix system automated certain benefits administration tasks and included features such as:                a. enrollment of beneficiaries through a limited-access, private computer network such as an business's internal computer network;        b. automated but limited application of certain basic business rules to inform the user, at the time of entry on-screen only, of certain limited missing information such as a beneficiary's address, birthdate dependents, or benefits plan choice;        c. automated reconciliation of payments provided they exactly match the amount invoiced to the customer;        d. limited automation of physical letter generation such as generation of a welcome letter to a new customer setting forth little more than the effective date of initiation of plan coverage for the customer;        e. automated maintenance of certain limited carrier data, including certain carrier rates and rating areas;        f. limited automation of Cobra enrollment by re-keying data for the Cobra enrollment into the system;        g. limited automation of open enrollment and re-qualification by automated sending out of notices and issuance of failure to re-qualify reports, allowing manual entry of termination if desired by the administrator;        h. automated termination and issuance of termination notice to the carrier upon first termination of a customer and thus well prior to conclusion of the re-instatement option period; and        i. limited periodic reconciling of payments actually received in-house by receipt at the system administrator's mailroom, routing to the finance department for entry into the system; if the payments matched exactly the amount of their respective invoices, the finance department would initiate a program through that would reconcile the cash received against the invoice; non-matching payments would require substantial manual involvement in the reconciliation process        j. The Phoenix system included numerous limitations and issues, however, including:        k. limited carrier data such as not including data (only zip codes and rates);        l. lack of automated creation of a Cobra record from information already in the system for a given beneficiary;        m. with regard to issuance of notices for enrollment or re-qualification, lacked ability select sub-groups (e.g., groups under 5 employees) for issuance of notices only to them, and also lacked automatic termination of groups that do not re-qualify;        n. providing notice of termination of a group to a carrier prior to expiration of a re-qualification period for the group including Cobra members of the group;        o. lack of automatic changing of employee status upon change of employee coverage (e.g., by changing from employee-only coverage to employee and spouse coverage), along with lack of automated corrected billing as a result of the change;        p. lack of automated reconciliation of cash upon closing of a batch of inputted premium checks, and automatic reconciling of premium notices with payments provided by multiple payments (e.g., multiple checks providing payment for a particular premium amount);        q. limited application of business rules to ensure correct data entry and limiting of enrollment as allowed by the rules, and relatedly, no ability to issue notices other than on-screen notices of certain limited types of information that may be missing;        r. limited ability to generate required notices, and limited or no ability to send notices through differing media (e-mail, mail, fax);        s. no ability to allow system access through remote or separate networks, such as via the Internet;        t. no ability to reconcile payments that do not exactly match invoice amounts, and no ability to issue notices based on matching discrepancies; and        u. limited data handling capacity, requiring periodic purge data to run the system.        